Risk Equivalence

Step 5 If Two or More Risk Factors are Present Without CHD or CHD Risk Equivalent, Assess 10-Year CHD Risk... 

In individuals who do not have established CHD or CHD risk equivalent, the next step is to count major risk factors for CHD as presented in Table 9-4. These risk factors are considered independent predictors of CHD. High-density lipoprotein cholesterol of greater than or equal to 60 mg/dL (1.55 mmol/L) is considered a negative risk factor and means 1 risk factor can be subtracted from the total count.3... 

CHD or CHD risk equivalents Less than 100 mg/dL Greater than or equal to Greater than or equal to... 

For patients without CHD or CHD risk equivalent, but two or more major CHD risk factors, perform Framingham risk assessment. 

The NKF suggests that CKD should be classified as a coronary heart disease (CHD) risk equivalent and the goal LDL-C level should be below 100 mg/dL in all patients with CKD.22 The most frequently used agents for the treatment of dyslipidemias in patients with CKD are the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors ( statins ) and the fibric acid derivatives. However, other treatments have been studied in patients with CKD and should be considered if first-line therapies are contraindicated. 

Diabetes mellitus is regarded as a CHD risk equivalent. That is, the presence of diabetes in patients without known CHD is associated with the same level of risk as patients without diabetes but having confirmed CHD. 

ATP III recognizes the metabolic syndrome as a secondary target of risk reduction after LDL-C has been addressed. This syndrome is characterized by abdominal obesity, atherogenic dyslipidemia (elevated triglycerides, small LDL particles, low HDL cholesterol), increased blood pressure, insulin resistance (with or without glucose intolerance), and prothrom-botic and proinflammatory states. If the metabolic syndrome is present, the patient is considered to have a CHD risk equivalent. 

PAD is a coronary artery disease risk equivalent, andaBPgoaloflower-extremity PAD CCBs may also be beneficial. /3-Blockers have traditionally been considered problematic because of possible decreased peripheral blood flow secondary to unopposed stimulation of a-receptors that results in vasoconstriction. However, /3-blockers are not contraindicated in PAD and have not been shown to adversely affect walking capability. 

The National Cholesterol Education Program considers ischemic stroke or TIA to be a coronary risk equivalent and recommends the use of statins in... 

Hypertriglyceridemia is associated with increased risk of coronary disease. VLDL and IDL have been found in atherosclerotic plaques. These patients tend to have cholesterol-rich VLDL of small-particle diameter and small, dense LDL. Hypertriglyceridemic patients with coronary disease or risk equivalents should be treated aggressively. Patients with triglycerides above 700 mg/dL should be treated to prevent acute pancreatitis because the LPL clearance mechanism is saturated at about this level. 

Diabetes is regarded as a coronary heart disease (CHD) risk equivalent LDL = low-density lipoprotein HDL = high-density lipoprotein. 

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